title: External jugular vein cross-over as a new technique for percutaneous central venous port access in case of left central venous occlusion.
abstract: OBJECTIVE
  To report the cross-over venous catheter technique in case of left-sided central venous (internal jugular, subclavian and innominate veins) occlusion and right-sided central vein patency.
  
  
  METHODS
  A 60-year-old right breast cancer patient presented with a local recurrence requiring chemotherapy. He presented with a left-sided catheter-related central venous occlusion and radiodermatitis of the right chest and neck. The nonsymptomatic side of insertion was defined as the patient's left side. Successful percutaneous left-to-right external jugular vein (EJV) cross-over access tips and tricks are reported. They include performing (a) the EJV access at the lower neck, (b) the 0.032 hydrophilic guidewire (GW) catheterization of the venous curves, (c) the GW anchor technique into the inferior vena cava, (d) the GW + Glidecath catheter stiffening technique and (e) the over-the-stiff wire implantable catheter push.
  
  
  RESULTS
  The cross-over technique was successful by using real-time ultrasonography/X-ray monitoring and interventional radiology tools (hydrophilic 0.032 in. and stiff 0.0035 in. GW and "J-shaped" Glidecath catheter) and the five-step technique.
  
  
  CONCLUSIONS
  In case of left innominate vein occlusion and necessity of left neck venous access, percutaneous EJV access should be attempted under real-time ultrasound/X-ray monitoring when other standard (subclavian venous port and internal jugular vein) routes are no longer available.
authors.affiliation: François Baclesse Cancer Research Institute, Caen Cedex - France.
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Marcy
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Hajjam
authors.forename: Alexis
authors.initials: A
authors.lastname: Lacout
authors.forename: Caroline
authors.initials: C
authors.lastname: Nöel
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Simon
authors.forename: Andrea
authors.initials: A
authors.lastname: Figl
mesh_terms: D061605:Administration, Intravenous; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016121:Brachiocephalic Veins; D018567:Breast Neoplasms, Male / Q000188:drug therapy* / Q000473:pathology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D003251:Constriction, Pathologic; D017809:Fatal Outcome; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D010690:Phlebography; D011855:Radiodermatitis / Q000150:complications; D015641:Radiography, Interventional; D013350:Subclavian Vein; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000970:Antineoplastic Agents